Rhinoplasty Forum and Chat

Support Forum, Chat, and Message Board for Patient's Questions and Answers Nasal Obstruction, Deviated Septum, Septoplasty, SMR, & Submucous Resection 3

Explore what others have to say about Nasal Obstruction, Deviated Septum, Septoplasty, Septorhinoplasty, and Plastic Surgery with answers by Dr. Michael Bermant, MD.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

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This is the page where you can review questions and stories from patients, view the opinions of lay persons, and see answers from Dr. Bermant and other physicians. Do you want to ask a question, post an answer, or make a comment? Information E-mailed to me will be considered for posting.

  • Why did you choose to have the surgery?
  • How did you choose your doctor?
  • How much did it cost?
  • Was the final cost the same as what you were told before the surgery?
  • How was the recovery?
  • Were there any complications? How were they resolved?
  • How do you feel about the results?
  • Did it have any effect on your life
    • emotionally
    • socially
    • sexually
    • professionally
  • How did others react to your surgery?
  • Did you learn any lessons?
  • What would you advise others?
Information posted in this section does not necessarily reflect the opinion of Dr. Bermant.

E-mail to Dr. Bermant

Rhinoplasty Nasal Surgery Important Information

Question: Re: nasal allergies

(please post on nasal obstruction bulletin board)

Dr. Bermant:

First of all, thank you for the Website. It's very informative.

I'm a 34 yr. old male who's suffered 20 years with a chronic sinus condition. Facial pressure, morning headaches, restricted sleep, nasal drip, and turbinate swelling (one nostril always blocked & the other half-blocked). Prior to surgery, I'd wake up from my sleep because of a lack of oxygen and extreme nasal congestion.

Referral to an otolaryngologist found I had the following: mildly deviated septum, hypertrophy of the turbinates, rhinitis, and chronic sinusitus. A CT scan showed the problem areas.

Surgery was March 14, and done as outpatient here in Atlanta. I arrived at 9am, surgery at 11am, and recovery from 2-5pm. The operation ran long because "I had a real mess up in there, including scar tissue and a large quantity of nasal polyps," my surgeon said. General anesthesia was used, and a wax-like packing was used. The nasal dressing was worn on the lip for 4 or 5 days afterward. Had to sleep upright, in a recliner, the first couple of nights. A week later I was back to work.

Today, five months later, the turbinate problem continues nearly as bad as before. Sinus drainage is improved. Septum is straight and the turbinates were trimmed, according to plan said my doctor. Doctor said on last visit "Some swelling of the soft tissue may still exist." Overall, I did get a small amount of relief.

Still, though, I'm "holding out" that it will get better. I'm going to give it a little more time. When should I consider a second turbinate operation? Or, assuming the defects were all corrected, should I visit a board-certified allergist as the next step towards wellness? You stated in a previous column that the sinuses "were not like copper plumbing" and that "you've got to deal with what causes them to swell." I think I might need to have an eosinophil test done to see if I have a type of non-allergy rhinitis. After all, the ENT did the "mechanical" repairs.

I'd like to have free and unrestricted breathing both day and night. What do you think I should do next?

Thank you for your help.

Sincerely,

S M

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Polyps, swollen mucosa, enlarged turbinates are all commonly found in noses that are reacting to allergic problems. Deformed nasal anatomy can lead to nasal passages closing off early in patients suffering with allergies. The underlying problem sometimes needs to be addressed first. You may want to check with your surgeon, but an evaluation by an allergist may be of use. There may be specific items a patient with allergies should be avoiding. Some patients can be made less sensitive with allergy shots over time. Making someone less sensitive DOES TAKE SOME TIME. The hardest thing for some is to be patient enough for the multiple treatments often necessary. For some patients intranasal steroids or antihistamines can provide relief during peak seasons of allergic problems.

Conservative surgery is important. Over resection of turbinates can cause severe problems. Nasal polyp recurrence is common. Check with your doctor about the need for possible further surgery. A good examination and evaluation would be necessary for such an answer.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Dr. Bermant:

I appreciate your reply to my questions concerning the sinus surgery. I honestly don't remember if I took the time to thank you when I rec'd. your message.

Thanks again.

S M

Hope all went well,

Michael Bermant, MD


Question: Re: deviated septum

I just had septoplasty and turbinate cautherization on wednesday. After the surgery I had an anxiety attack because of the packing. Thank God for percocet, it helped me get through the ordeal. As far as my symptoms before surgery; I have had a history of going to the dentist with toothaches, but with out them finding anything wrong with my teeth. I have had root canals based on where I thought the pain radiated from. When this episode started I was going to go back to a dentist but I found that I could reduce the pain by stuffing my right nostril with cotton and sealing off the outside air. The symptoms changed to where I could not sleep on my right side because of the pain.This made me think that It might be sinus problems, so I went to an ENT. The ENT recommended surgery after reading the CT scan. The scan showed a deviated septum and some blockage on my right side. After surgery he said he was pleased the way things went and my problems should be eliminated. He said he removed bones spurs, and that my anatomy now should keep the air humidified in my sinuses. I am scheduled to get the gel splints removed this wednesday. It makes my wonder why after going to so many dentists for years struggling with facial pain that they wouldn't recommend me to see an ENT. Well thats my story. I hope it might help somebody out there with the same symptoms.

thanks,

B C

Dr. Bermant responds:

This should not be construed as medical advice.

The bottom of the nose and maxillary sinus is the same bone as the top of the mouth (palate). Sensation nerves that supply the upper teeth and palate join the nerves that line the maxillary sinus and parts of the nasal passageway. Irritation of one area may be very much like irritation in the other. I use special techniques and am generally am able to avoid the use of packing.

Remember both Plastic Surgeons and ENT's both take care of this problem depending on their training and expertise. I am a Plastic Surgeon boarded by the American Board of Plastic Surgery.

Good luck and I hope your problem is solved.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: Nasal surgery

I have much difficulty breathing through my nose-especially the right side. This is very stressful. I had a rhinoplasty and septoplasty in 1989 that apparently caused at least part of the problem. I went to an ENT earlier this year, and he did a partial turbinectomy. This has not helped. Two plastic surgeons have said that I need a speader graft in my nose to open the closed nostrils. One of the two mentioned that he also read an article recently about turning the cartilages over to open the nose. Two questions. First, how successful are spreader grafts? Second what about the idea of turning the cartilages over?

Thank you.

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

The inside front part of the nose acts as a valve to air flow. It is like a tent with the top of the tent being the front of the nose, the center stake is the septum, and the walls of the tent are the sides of the nose. A bent center pole (septum) can obstruct airflow. However if the walls of the tent are too close to the tent pole (internal valve not open) airflow is also restricted. The internal valve functions to control the flow of air so that humidity can be maintained.

There are several maneuvers to improve the angle of the internal nasal valve when it constricts the airflow. A spreader graft puts a small spacer of cartilage at the juncture of the tent pole and wall - spreading the wall away from the septum. Other operations can provide the same result but what procedure is best for anyone patient depends on the defect needing correction and surgeon's preferences.

You need this conversation with the surgeon who will be performing your operation as we have our own methods and preferences. I cannot comment what is best without an examination. If your surgeons do not want to help with the education process, are you with the right doctors?

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: Choosing a surgeon

Dear Sir:

I am having difficulty breathing through my nose from a rhinoplasty/septoplasty operation performed in 1989. It did not bother me the first six years, but now it is a constant nuisance. My right side is touching on the inside which makes it impossible to breath through that side. My question is this. Two plastic surgeons have indicated the need for spreader grafts. One is the plastic surgeon who did the original procedure. Would it be better to go back to the original one since he knows what he did the first time, or due to my current difficulties would it be better to go to the new doctor. Both are board certified.

Thank you.

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

The internal valve of the nose helps regulate the flow of air. If the outside wall of the nose is too close to the septum, air cannot get through. Spreader grafts help move the outside wall away from the septum. When making a nose smaller, there can be a reduction in the nasal airway itself. Scars can also limit how the valve works. A nose also evolves in life as well as after surgery such that this problem may or may not be from the surgery itself.

Without an examination and evaluation it is impossible to hazard a guess if your problem is a normal complication of the surgery, possible trauma, or a natural evolution of your nose.

There are many factors that each patient must weigh before choosing a doctor. Who do you feel most comfortable with? Who spends enough time with you and your questions? Who has better experience and skill?

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: sinus infection, surgery

I had a sinus infection 10 years ago which caused me to consult with an ENT. He said that I had a deviated septum, and would be prone to such infections until I had this treated. I didn't have the surgery at the time because I had no insurance coverage, and also because my Dad had had the surgery as a teenager, with poor results.

I am living in New Mexico now. I have a two year old daughter, and pretty severe respiratory allergies (recently, I have gotten a lot of relief for the allergies by using Nasalcrom). I have had two sinus infections this year, and possibly more that were never diagnosed because I didn't seek treatment. The infection I am suffering from now is particularly virulent and has spread to my ears as well. I already have a moderate hearing loss and this is unnerving.

Because of all these things, I am reconsidering whether I should have corrective surgery. My questions are how long am I likely to be laid up, and what is the typical cost of the surgery? Is it likely to be covered by medical insurance?

Thanks for your attention

D J

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Sinus infections can be caused by obstruction of the passageways between the nose and sinuses. Allergies and anatomical deformities can both contribute to this problem. Which will be a greater problem will vary from patient to patient. You may benefit from minimizing your allergic exposure and working with your allergist. Some allergic swelling is difficult to prevent. If the nasal passageway is already compromised, smaller swellings can close off the openings. Surgery may be a very good option but will not cure you of your allergic problems.

Surgical costs depend on what is done. Septoplasty, septorhinoplasty, turbinate resection, polyp resection, and opening up sinuses all have different prices. Septoplasty and Septorhinoplasty costs vary depending what needs to be done. Most insurances usually (and should) cover this problem, but some have been trying to find creative methods to deny all sorts of medical care payments.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: Nasal surgery

Dear Sir,

I am having tremendous difficulty breathing through the right side of my nose. Two plastic surgeons have told me that I need to have a cartilage splint placed in my nose to hold the nostrils open. One of the surgeons also suggested using a new technique in which he would turn over the cartilage to form a convex shape instead of a concave shape. Please give me your thoughts on the success rate of both of these procedures. My nostrils were narrowed during a rhinoplasty operation from 1989, however, the breathing difficulties just started within the last two years. The Breath Right strips help tremendously at night.

Thank You.

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

The inside front part of the nose acts as a valve to air flow. It is like a tent with the top of the tent being the front of the nose, the center stake is the septum, and the walls of the tent are the sides of the nose. A bent center pole (septum) can obstruct airflow. However if the walls of the tent are too close to the tent pole (internal valve not open) airflow is also restricted. The internal valve functions to control the flow of air so that humidity can be maintained.

There are several maneuvers to improve the angle of the internal nasal valve when it constricts the airflow. A spreader graft puts a small spacer of cartilage at the juncture of the tent pole and wall - spreading the wall away from the septum. Other operations can provide the same result but what procedure is best for anyone patient depends on the defect needing correction and surgeon's preferences.

You need this conversation with the surgeon who will be performing your operation as we have our own methods and preferences. I cannot comment what is best without an examination. Different problems need different solutions. If your surgeons do not want to help with the education process, are you with the right doctors?

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: nasal reconstruction

I need the aylar cartilage in my left nostril rebuilt. It is collapsed, due to a botched septoplasty that was performed 17 years ago. Also need some septum work (saddle, deviated septum), need a polyp removed, and possibly some sinus work. Who would you recommend?

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

We offer such surgery in my practice, but not without an evaluation, examination, and determination of surgical options. I am sorry but I cannot act as a referral service.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: Rhinoplasty

Dear Dr. Bermant

I enjoyed going through your web-page. It was quite interesting yet educational. I leave in Austin Tx. I have a deviated septum. while I would like to take care of that problem i also would like to reshape the hump on my nose other words i am also a rhinoplasty candidate. My case is more like the fist case you show in your web page at ...

I however, do not know any good dr. in this area and do not know how to go by looking one up. Since i enjoyed your web-page so much i thought i could ask you to refer me to one of you colleagues. I appreciate any help you could offer.

Thanks

Regards

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Thank you for your kind comments about plasticsurgery4U website. It is a window to our practice and our dedication to patient education.

It certainly sounds like you would benefit from an evaluation and examination by a competent board certified plastic surgeon to explore the possibilities of septorhinoplasty. Patients come to see us from far away. I am sorry but my staff and I have to concentrate our time and energies on our own patients. There are just not enough hours in the day to act as a general referral service and keep up with our practice.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Dear Sir,

This is a good letter! I had sinus surgery and septoplasty on ---. It is now 4 days later and I had my packing removed. Oh what a difference. I have felt no pain and already have significant increase in breathing capability. My septum blocked over 80% of my right nostril. My sinuses were severely diseased and had immense pressure all the time.

The first 4 days after surgery were quite uncomfortable but, once the packing was removed it felt like a cork be pulled out of a champagne bottle. INSTANT RELIEF! Anyone who has to have this surgery DO IT! I feel better and breathe better. It's only been 4 days. No pain, just pressure. It was well worth it!!!!!!!

Dr. Bermant answers:

I am glad things went well with you and your doctor. Just think how nice it may have been if there was no packing. I have been using special techniques that permit me to avoid the use of packing in most patients. Good luck on your continued recovery.

Michael Bermant, MD

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